A well-known is the fact that the complex system of neuroendocrine regulation of the menstrual cycle involves a lot of levels, each of which has a mutual relationship with each other. Disorders on one of the links in the system will inevitably lead to violations of other levels. One of the clinical manifestations of this kind of change is the absence of menstruation (or amenorrhea).

In what forms can manifest amenorrhea

Amenorrhea is characterized by the absence of cyclical changes in a woman's body, which ultimately leads to a hormonal deficiency and lack of ovulation Ovulation - How to determine as accurately as possible?   If cyclic changes do not occur in the whole body (i.e., in the reproductive system and the whole organism as a whole), this form true amenorrhea .  There are situations when the hormonal activity of a woman saved, but there is no menstrual bleeding .  An obstacle to highlight the blood can be a variety of defects, imperforate cervical canal, the effects of scarring .  Blood that flows cyclically, accumulates not only the vagina and the uterus, tubes and the abdominal cavity (in rare cases) .  It is a kind of false amenorrhea .  The development of a true pathologic amenorrhea due to the influence of various unfavorable factors .  These factors can be a large number, but the root cause is damage to one of the levels of the neuroendocrine system .  The pathological process which occurs at any of these levels leads to the fact that the cyclic changes in a woman temporarily absent or completely break off .  There are several levels of destruction and, accordingly, several clinical variants of amenorrhea:

• central form, associated with damage to the area of ​​the cerebral cortex and the hypothalamus-pituitary
• gonadal or ovarian form developing with the defeat of the ovaries
• masterbatch form, as a consequence of pathological changes at the level of the uterus
• amenorrhea due to endocrine hormone synthesis defect (in the pathology of the endocrine glands, adrenal glands and thyroid)

The absence of the menstrual cycle due to central damage associated with dysfunction of the cortical and subcortical structures from damage (hypothalamic-pituitary form amenorrhea). The main value in the event of violations of this form is given to the adverse effects of environmental factors. This might be the consequences of trauma, exposure to toxic substances, prolonged stress How to beat stress? Create an oasis , Complicated course of a woman's pregnancy and childbirth. Amenorrhea also may develop as a result of anatomical abnormalities in the hypothalamic-pituitary region, for example, the formation of hormonally active pituitary tumors (prolactinomas and other mixed forms of tumors). Regardless of the causes of the defeat, is a violation of the cyclic secretion of pituitary hormones, which leads to a change in hormonal activity at the level of the reproductive system, that is, the process is broken at the level of ovarian steroidogenesis.

If a primary lesion at the level of the gonads or ovaries with preserved function of the pituitary gland, there is ovarian amenorrhea .  Preferential damage the ovaries leads to a lack of hormonal activity of the ovaries .  When the innate nature of the disease develop a form of amenorrhea, which is known as the syndrome of gonadal dysgenesis or Turner .  This syndrome is characterized by congenital malformations, which leads to the formation of incomplete sets of chromosomes (one missing sex chromosome) .  Changes in the reproductive system are expressed in the absence of menstruation and infertility .  If amenorrhea is associated with disturbances at the level of the uterus, the pathology of the menstrual cycle is associated with the processes that cause changes in the endometrium .  As causal factors may act inflammatory transferred intrauterine intervention and uterine congenital insensitivity to sex hormones .

Can this state be considered the norm

Not all situations related to the lack of a menstrual cycle, are pathological states. In some cases, it has a natural or physiological importance. The natural process is the lack of menstrual period before puberty Puberty child - stages of a complex path   (ie, childhood), the entire period of pregnancy and during breastfeeding, and in the waning of female reproductive function or menopause. The girl with the defective maturation of her neuroendocrine system is not cyclic changes in the secretion of sex hormones, which accounts for the absence of the menstrual period. When it first menstruation (menarche or) may require more specific time to fully established cyclic regimen of hormone secretion. In some cases, this process may take one year. During aging, on the contrary, all processes undergo reverse development, there comes a fading of the physiological processes taking place in the reproductive system of a woman and it leads to the cessation of menstruation (amenorrhea menopause).

During pregnancy, amenorrhea due to a temporary suspension of cyclic processes in the ovaries. The dominant importance given to production of the hormone progesterone, the content of which is increased in this period. It progesterone Progesterone - norm and pathology   prevent rejection of the endometrium. It is also crucial in the occurrence of amenorrhea after delivery surrenders increased levels of pituitary hormone prolactin, as it is depressing for production of pituitary hormones. Amenorrhea, which occurs in women during lactation, lactation is called and prevents the onset of pregnancy during the entire period of breastfeeding.

Marina Solovyov

Uterine fibroids is frequently diagnosed gynecologic diseases. This pathology occurs in women of reproductive age (about 30% of women suffer from uterine cancer). Uterine fibroids fairly easily diagnosed and respond well to treatment with the small size of the uterus. A characteristic symptom of uterine fibroids are plentiful monthly. However, heavy menstruation arise not just in the development of the disease. Basically, this feature is dependent on the size and location leiomyomata. Regular monitoring allows the doctor to patients with uterine myoma avoid various complications, which provoke heavy menstruation.

Hysteromyoma

Uterine myoma is a benign gormonalnozavisimym disease in which the body of the uterus formed assemblies consisting of muscle and connective tissue. The most common uterine cancer affects women of 35-50 years. After menopause fibroids usually fades independently. The emergence of this disease associated with hormonal disorders (increased production of estrogen and progesterone production decline). Depending on the location of fibroids isolated interstitial myoma (nodes are located within the wall of the uterus), subserous (nodes are located on the outer surface of the uterus), and submucosal fibroids or submucosal, with a node or nodes are located in the cavity of the uterus and grow inwards.

The causes of uterine fibroids

For reasons that provoke the disease include:

• hormonal disorders (late onset of menstruation, irregular menstruation, heavy periods);
• genetic predisposition;
• surgery on the uterus (dilatation and curettage, abortion, difficult births);
• irregular sexual life;
• concomitant extragenital pathology (diabetes, high blood pressure, obesity);
• sedentary lifestyle (sedentary work).

The clinical picture

As noted above, one of the typical symptoms of uterine fibroids are abundant menstruation .  This feature is particularly frequent appearances at large (more than twelve weeks) of fibroids .  The incidence of heavy menstrual period at this disease depends on the location of fibroids .  Thus, the most unfavorable prognostic is submucosal fibroids .  This is primarily due to the increase in the surface of the uterus, and therefore the area increases mucosal .  In addition, submucosal fibroids dangerous complications such as birth myoma node, which is accompanied by profuse uterine bleeding and requires surgical intervention .  Violation of the menstrual cycle in the presence of uterine fibroids are reduced to shorten it and the appearance of painful menstruation .  Abundant month in this disease occur in the presence of concomitant pathology of the endometrium Endometrial pathology - what the consequences might be   (which is also associated with hormonal imbalance). Long-term and heavy uterine bleeding lead to anemizatsii sick, which is manifested in weakness, fatigue, dizziness. Skin becomes pale, blood pressure decreases.

Diagnostics

Diagnosis of uterine fibroids is easy. Already during the pelvic exam Gynecological examination: an important component of women's health   the doctor can determine an enlarged uterus and lumpy. As an additional survey used ultrasound pelvic metrosalpingography Metrosalpingography: diagnosis of infertility   and hysteroscopy. In difficult cases, using computed tomography and magnetic resonance imaging.

Treatment of heavy menstrual period when uterine fibroids

Conservative treatment of uterine fibroids the size of the uterus is held with less than twelve weeks, and the absence of concomitant gynecological diseases. For the treatment of menorrhagia (heavy menstruation) use hormones. These include oral contraceptives, derivatives of androgens (Danazol, Gestrinone) and progesterone analogues Progesterone - norm and pathology   (Duphaston). In addition, parallel to the appointed Antianemic preparations (iron agent). Surgical treatment is to remove uterine fibroids or husking.

Anna Sozinova